Hepatocellular carcinoma in HIV-infected patients: Check early, treat hard

Massimiliano Berretta, Elisa Garlassi, Bruno Cacopardo, Alessandro Cappellani, Giovanni Guaraldi, Stefania Cocchi, Paolo de Paoli, Arben Lleshi, Immacolata Izzi, Augusta Torresin, Pietro di Gangi, Antonello Pietrangelo, Mariachiara Ferrari, Alessandra Bearz, Salvatore Berretta, Guglielmo Nasti, Fabrizio di Benedetto, Luca Balestreri, Umberto Tirelli, Paolo Ventura

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose. Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era. The aims of this study were to describe HCC tumor characteristics and different therapeutic approaches, to evaluate patient survival time from HCC diagnosis, and to identify clinical prognostic predictors in patients with and without HIV infection. Patients and Methods. A multicenter observational retrospective comparison of 104 HIV-infected patients and 484 uninfected patients was performed in four Italian centers. HCC was staged according to the Barcelona Clinic Liver Cancer (BCLC) criteria. Results. Tumor characteristics of patients with and without HIV were significantly different for age, Eastern Cooperative Oncology Group performance status (PS) score ≤1, and etiology of chronic liver disease. Despite the similar potentially curative option rate and better BCLC stage at diagnosis, the median survival time was significantly shorter in HIV + patients. HIV + patients were less frequently retreated at relapse. Independent predictors of survival were: BCLC stage, potentially effective HCC therapy, tumor dimension ≤3cm, HCC diagnosis under a screening program, HCC recurrence, and portal vein thrombosis. Restricting the analysis to HIV + patients only, all positive prognostic factors were confirmed together with HAART exposure. Conclusion. This study confirms a significantly shorter survival time in HIV +HCC patients. The less aggressive retreatment at recurrence approach does not balance the benefit of younger age and better BCLC stage and PS score of HIV + patients. Thus, considering the prognosis of HIV + HCC patients, effective screening techniques, programs, and specific management guidelines are urgently needed.

Original languageEnglish
Pages (from-to)1258-1269
Number of pages12
JournalThe oncologist
Volume16
Issue number9
DOIs
Publication statusPublished - Sep 2011

Keywords

  • AIDS
  • Hepatitis C virus
  • Hepatocellular carcinoma
  • Highly active antiretroviral therapy
  • HIV

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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